gastrointestinal Flashcards

1
Q

if a pt has primary sclerosing cholangitis, what would indicate a decrease in the synthetic function of the liver and the need for a liver transplant

A

prolonged PT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

which demographic and syndrome is primary biliary cholangitis associated with

A

middle aged females
sjogrens syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is Wilsons disease and what is it characterised by

A

hepatic jaundice due to excessive copper deposition in liver / brain / cornea
characterised by
- reduced serum caeruloplasmin
- reduced total serum copper
causes psychiatric problems - speech/swallowing/physical coordination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

which clinical sign is associated with raised oestrogen in cirrhosis

A

palmar erythema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

which clinical sign is associated with portal hypertension in cirrhosis

A

caput medusae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is terlipressin used for

A

treatment of bleeding oesophageal varicies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is the cause of jaundice in the presence of deranged liver function tests and anti mitochondrial antibodies

A

primary biliary cholangitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is given before the administration of glucose in wernickes encepahlopathy

A

IV thiamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is used when there’s reduced consciousness due to cerebral oedema in hepatic encephalopathy

A

IV mannitol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what helps to reduce encephalopathy by facilitating nitrogenous waste loss through the intestines

A

lactulose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is used to reduce oedema or ascites in liver cirrhosis

A

spironolactone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are the most common bacteria associated with spontaneous bacterial peritonitis

A

e coli
k pneumoniae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

prophylactic treatment for spontaneous bacterial peritonitis

A

Abx: ciprofloxacin or norfloxacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what s the initial investigation if see someone unstable and confused, smelling of alcohol and has signs of liver failure

A

blood glucose - to rule out hypoglycaemia
then do LFTs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is disulfiram used for

A

Is an aldehyde dehydrogenase inhibitor used in patients with alcohol dependency
Causes unpleasant symptoms on alcohol consumption which helps them abstain from drinking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

If a patient has hepatic encephalopathy which medication can reduce confusion

A

Lactulose
- chlordiazepoxide is for pts at risk of alcohol withdrawal and is CONTRAINDICATED in pts with hepatic encephalopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is Gilbert’s disease

A

benign condition (no treatment needed) in which there is decreased activity of the enzyme that conjugates bilirubin
this means you get unconjugated hyperbilirubinaemia during fasting, stress, exercise, illness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

likely diagnosis if someone gets jaundice in ramadan

A

gilbert’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is the most common complication of acute liver failure

A

bacterial infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

which antibiotics should be avoided when treating HAP in a pt with acute liver failure and why

A

gentamicin - can cause renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

which resp condition requires needle decompression

A

tension pneumothorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

when would you give FFP

A

if there is evidence of haemorrhage / bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

when is IV mannitol given

A

if suspected raised intracranial pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

treatment if pt has bibasal crepitations on inspiration

A

IV furosemide - as they have pulmonary oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

which symptom specifically indicates primary biliary cirrhosis

A

pruritus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

which antibiotic can cause jaundice

A

co amoxiclav

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what does dry cough and red nodules on shin indicate

A

sarcoidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what does the triad of abdominal pain, ascites, tender hepatomegaly indicate

A

Budd Chiai syndrome - thrombosis of hepatic vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what is the most likely diagnosis for an older pt presenting with anaemia, dyspnoea, palpitations, headaches, easy bruising, bone pain, splenomegaly

A

myelofibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

main treatment for confusion due to hepatic encephalopethy

A

ORAL lactulose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what is given for symptomatic relief of alcohol withdrawal

A

chlordiazepoxide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what is given to prevent wernickes encephalopathy

A

IV thiamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what does a cloudy ascitic fluid tap indicate

A

infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

an INR over which number is indicative alone for urgent liver transplant

A

INR > 6.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what is the triad of acute liver failure

A

encephalopathy
jaundice
coagulopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what causes leuchonychia in chronic liver disease

A

hypoalbuminaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what causes excoriations/pruritis in chronic liver disease

A

raised serum bilirubin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what ammonia levels are seen in liver failure

A

high

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

medication used to reduce recurrence of hepatic encephalopathy

A

rifaximin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

3 meds for hepatic encephalopathy and what they’re used for

A

oral lactulose - for confusion, causes loss of toxins via gut
IV mannitol - for reduced consciousness, reduces ICP
rifaximin - for prevention of recurrence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

pruritus + pale stool + dark urine = what kind of jaundice

A

obstructive jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

iif a pt has jaundice and breathlessness (but no smoking history and bronchodilators are ineffective) what os the most likely cause

A

low serum alpha 1 antitrypsin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

describe the microscopy results of ascitic tap for SBP

A

neutrophil count > 250 /uL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

treatment for SBP

A

IV ceftriaxone / ciprofloxacine / cefotaxime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

how many hours after abstinence from alcohol does delirium terms occur

A

48 - 72 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

what are the LFTs and other blood results for alcoholic hepatitis

A

AST>ALT (2:1)
elevated GGT
non megaloblastic macrocytic anaemia
increased ALP (but less than ALT and AST)
increased bilirubin
decreased albumin
increased PT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

if have a pt who smells of alcohol, has signs of chronic liver disease and seems very confused, what’s the first investigation

A

blood glucose to rule out hypoglycaemia , then do LFTs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

symptomatic relief of alcohol withdrawal

A

chlordiazepoxide
vitamin C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

prevention of wernickes encephalopathy

A

pabrinex (IV thiamine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

what medications are given following successful alcohol withdrawal

A

Acamprosate - for abstinence
Disulfiram
Naltrexone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

which autoimmune hepatitis occurs in children only

A

type 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

what is the most common type of autoimmune hepatitis

A

type 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

antibodies for type 1 A.I hepatitis

A

anti smooth muscle antibodies (ASMA)
anti nuclear antibodies (ANA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

antibodies for type 2 A.I hepatitis

A

anti liver kidney microsomal 1 antibodies
(anti LKM1)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

antibodies for type 3 A.I hepatitis

A

anti soluble liver antigen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

what is a sensitive markers for ischaemic hepatitis

A

significant rise in LDH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

what is the highest LFT in viral hepatitis

A

ALT (ALT >AST)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

describe the serology results in AI hepatitis

A

high IgG (hypergammaglobulinaemia)
ANA / ASMA / A-LKM1 / anti-solube liver antigen antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

which hepatitis is characterised by high IgG

A

auto immune hepatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

treatment for AI hepatitis

A

Induction therapy : prednisolone (corticosteroid)
Maintenance therapy : azatioprine (immunosuppressant)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

which hepatitis present predominantly in young/midddle aged women

A

autoimmune hepatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

with class of antibody indicates previous or chronic infection

A

IgG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

which class of antibody indicates current / acute infection

A

IgM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

most common viral hep in developing countries

A

hep A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

most common viral hep globally

A

hep B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

causes of viral hepatitis

A

ABCDE ACE

Hep A
Hep B
Hep C
Hep D
Hep E

Adenovirus
CMV
EBV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

what virus causes hep a / b /c / e

A

Hep A = RNA picarnovirus
Hep B = hepadnavirus
Hep C = RNA flavivirus
Hep E = calcivirus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

which hep virus is asymptomatic

A

hep c

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

with which hep virus do most people develop chronic infection

A

hep c

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

hep a / b / c mode of transmission

A

a = faecal - oral
b = blood/body fluids
c = blood/body fluids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

with which hep virus do most people develop jaundice

A

hep a
(some adults do with hep b, hep c is usually asymptomatic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

what is the serology of someone with chronic hep b infection with high viral replication

A

positive anti HBcIgG antibodies
positive hepB antigen
positive HBeAg
positive HBsAg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

which Hep B antibody indicates previous vaccination

A

antibody against HbsAg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

which Hep B antibody indicates previous infection

A

IgG antibody against HbcAg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

which Hep B antigen indicates high infectivity / high viral replication

A

HbeAg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

1st and 2nd line treatment for hep B

A

1st = Peginterferon, alpha 2a
(interferon alpha)
2nd = Tenofovir, Entecavir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

treatment for hep c

A

DAAT
nucleoside analogues eg sofosbuvir+ ribavirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

characteristic symptoms of ascending cholangitis

A

charcots triad
RUQ pain
Fever
Jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

what is fibrosis

A

fibrosis of liver tissue into regenerative nodules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

what causes palmar erythema in cirrhosis

A

increased oestrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

what causes leuchonychia in cirrhosis

A

low albumin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

what causes caput medusae in cirrhosis

A

portal HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

what is fetor hepaticus and what is it a sign of

A

rotten eggs/garlic smelling breath
sign of liver cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

clinical signs of liver cirrhosis

A

palmar erythema
dupuytren contracture
caput medusae
spider naevi
fetor hepaticus
pruritus
plantar erythema
gynaecomastia
jaundice
oesophageal varices
oedema
ascites
splenomegaly
smaller liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

what is the most specific and sensitive test for liver cirrhosis

A

liver biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

what is done in liver cirrhosis every 6 months to screen for hepetocellular cancer

A

liver ultrasound
AFP levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

what is done to check for varicies in pts with liver cirrhosis

A

upper GI endoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

how to mange ascites due to liver cirrhosis

A

sodium restriction
spironolactone
paracentesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

what surgical procedure can treat portal hypertension to reduce the risk of oesophageal varices

A

TIPS (transoesophageal intrehepatic porto systemic shunt)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

what treatments are required if a pt with liver cirrhosis has haematemesis / malaena

A

terlipressin (vasopressin analogue)
IV Abx
Vit K / FFP (PT>20) / blood or platelet transfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

what med is used as a prevention to reduce recurrence of hepatic encephalopathy

A

rifaximin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

triad of liver failure

A

coagulopathy (INR > 1.5)
jaundice
encephalopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

what treatment is given for paracetamol overdose leading to liver failure

A

N -acetylcysteine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

what does asterixis in liver failure indicate

A

hepatic encephalopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

prophylactic Abx for SBP

A

ciprofloxacin or norfloxacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

how long after last drink does delirium tremens occur

A

48-96 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

which tumour marker is used for hepatocellular carcinoma

A

AFP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

what is the most likely diagnosis of someone with COPD and liver cirrhosis

A

alpha - 1 - antitrypsin deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

what is the number of units per day and the audit score baseline for recommending assisted alcohol withdrawal (eg chlordiazepoxide)

A

over 15 units per day
AUDIT score of over 20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

what type of bilirubin is high in gilbert’s syndrome

A

unconjugated bilirubin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

what do you measure to confirm diagnosis of Wilsons disease

A

ceruloplasmin levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

likely diagnosis in a 22 year old with jaundice, tremor, affected speech

A

Wilsons disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

what is a subacute history with tender hepatomegaly and ascites suggestive of (pt has had no recent travel and doesn’t drink)

A

liver ischaemia due to budd chiari syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

investigation for Budd chair syndrome / liver ischaemia

A

US liver with Doppler flows

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

what is the serum copper level in Wilsons disease

A

LOW - bc copper is deposited the tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

what vitamin deficiency causes wernickes encephalopathy

A

vitamin B1 (thiamine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

triad of werncikes encephalopathy

A

ataxia
confusion
opthalmoplegia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

first line treatment for Wilsons disease

A

penicillamine
(remember like “copper Penny”)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

what is the LFT results for AI hep

A

raised ALT and AST compared with ALP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

which type of bilirubin can be found in the urine

A

conjugated bilirubin - as this is water soluble

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

which type of bilirubin is high in Gilberts syndrome

A

unconjugated bilirubin - only yellow skin and sclera not poo/pee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

which gene mutation is responsible for Gilberts syndrome

A

UGT1A1 gene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

initial step if pt took paracetamol overdose more than 15 hours ago

A

start N acetyl cysteine immediately

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

initial step if pt took paracetamol overdose 4 - 15 hours ago

A

check blood paracetamol conc and commence treatment accordingly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

what are the 3 situations where you should start N acetyl cysteine immediately for paracetamol overdose

A
  • staggered overdose
  • if ingestion was more than 15 hours ago
  • if there is uncertainty about timing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

pathophysiology of delirium tremens

A

unopposed glutamate activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

what is the LFT results in non alcoholic fatty liver disease

A

mild increase in AST and ALT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

how do you diagnose non alcoholic fatty liver disease

A

liver biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

what is Budd chiari syndrome

A

obstruction of hepatic veins (often by thrombosis)
- hepatomegaly
- ascites
- abdo pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

for paracetamol ingestion, what Ph would indicate immediate liver transplant

A

pH < 7.3 at 24hrs post ingestion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

what is naloxone used for

A

to treat and reverse opioid toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

how do you reduce risk of renal impairment in pts with SBP

A

give HAS (human albumin solution)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

give 2 contraindications to performing an ascitic tap

A

infection on skin overlying area intended to insert needle into
disseminated intravascular coagulopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

how do you calculate SAAG (serum-ascites albumin gradient)

A

serum albumin - ascites albumin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

what are the causes of ascites if SAAG > 11 g/L and what type of ascites is it

A

ascites is transudative (low albumin)
causes:
portal HTN
liver cirrhosis
alcoholic liver disease
liver failure
Budd-Chiari syndrome
congestive heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

what are the causes of ascites if SAAG < 11 g/L and what type of ascites is it

A

ascites is exudative (high protein)
causes:
MIPN
- malignancy / malnutrition
- infection (eg TB)
- pancreatitis
- nephrotic syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

treatment for ascites

A

dietary sodium restriction
spironolactone
ascitic tap / paracentesis (give Iv albumin when doing large volume paracentesis)
AbX for SBP prophylaxis (ciprofloxacin / norfloxacin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

2 main side effects of spironolactone

A

gynaecomastia and hyperkalemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

wheat do you give for ascites if the max dose of spironolactone isn’t working

A

add furosemide to the spironolactone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

what to give during large volume paracentesis

A

IV albumin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

initial investigation of ascites

A

abdo USS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

sign on examination suggesting ascites

A

shifting dullness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

treatment of oesophageal varices due to portal HTN

A

terlipressin + IV Abx
consider TIPS (transjugular intrahepatic portosystemic shunt)
Prophylactic Beta blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

what is raised in ascitic tap for SBP

A

neutrophils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

what suggests SBP in an ascitic tap

A

ascitic fluid white cells > 250/mm3 which are predominantly neutrophils (PMN - polymorphonuclear neutrophils)
or
ascitic fluid contains neutrophils > 250/mm3 neutrophils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

what is raised in ascitic tap for intra abdominal malignancy

A

lymphocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

what is constipation defined as

A

irregular bowel movements
=< 3 bowel movements per week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

give 3 groups of medication that cause consitpation

A

CCBs
antipsychotics
opiates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

what is primary and secondary constipation

A

primary = due to dehydration, low fibre diet, lack of exercise
secondary = due to diverticulosis, diverticulitis, haemorrhoids, bowel obstruction, IBS etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

treatments for consitaption

A

1st: dietary and lifestyle modifications (more fluids, fibre exercise)

Bulk laxatives and tool softeners
Osmotic laxatives - eg lactulose
stimulant laxatives - eg senna
prunes - natural laxatives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

what are the 4 main types of laxatives

A

bulk laxatives
osmotic laxatives
simulant laxatives
stool softener laxatives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

when might constipation cause confusion

A

faecal impactation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

bristol stool chart (type 1 -7)

A

1 - hard lumps, like nuts
2 - sausage shape but lumpy
3 - sausage shape with cracks on surface
4 - smooth sausage
5 - soft blobs, clear cut edges
6 - fluffy pieces, ragged edges, mushy
7 - watery, no solid pieces

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

investigations for constipation

A

anal manometry
FBC - ion deficiency anaemia
TFTs - hypo thyroidism
AXR - rectal mass, faecal impactation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

Rome IV diagnostic criteria for functional constipation in adults

A
  • at least 2
  • in the past 1/4 or more of defections
  • in past 12 weeks
  • with symptoms ongoing for 6+ months
  • 3 or less bowel movements per week
  • sensation of incomplete evacuation
  • sensation of anorectal obstruction / blockage
  • manual aid to evacuate stool
  • straining attempts to defecate
  • hard/lumpy stool
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

constipation red flags in children

A

meconium passage delayed (over 48 hours)
consitpation within first month of life
bilious vomiting
blood in stool
fever
family history of related disease
severe abdo distention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

constipation red flags in adults

A

family history
iron deficiency anaemia
blood in stool
palpable ado mass
reduced stool caliber
weight loss
recall prolapse
sudden onset
unresponsive to medication
>50 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

what counts as chronic anal fissure

A

over 6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

primary vs secondary anal fissure

A

primary - due to local trauma
secondary - due to underlying disease eg previous anal surgery, IBD, infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

acute anal fissure management (<1 week)

A

conservative
- fluids
- diet modifications
- bulk forming laxatives and stool softeners
- lubricant / petroleum jelly application prior to defacation
- sitz bath

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

chronic anal fissure (>6 weeks)

A

analgesia
- topical GTN
- topical diltiazem

for persistent fissures
- botox
or surgical sphincterectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

grades I - IV for internal fissures

A

I - bleeding, no prolapse
II - prolapse, reduces spontaneously
III - prolapse, can be technically reduced
IV - prolapse, cannot be reduced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

internal vs external sphincter

A

internal - above denate line, painlesss
external - below denate line, can be painful and prone to thrombosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

how can you tell if a haemorrhoid is thrombosed

A

v painful
purple
oedematous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

1st line diagnostic investigation for haemorrhoid

A

anoscopic examination (protoscopy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

1st line management for all haemorrhoid patients

A

dietary and lifestyle modifications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

management for haemorrhoid grades I - IV

A

I = topical corticosteroids (relives pruritis)
II-III = Rubber band ligation
IV = surgical haemorrhoidectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

which class of proteins triggers coeliac disease

A

gliadin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

which skin manifestation is seen in coeliac disease

A

dermatitis herpetiformis
(itchy papulovesicular lesions on extensor surfaces of skin esp elbows)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

1st line and gold standard diagnostic investigations for coeliac disease

A

1st line : serology
- increased IgA tTG / anti-endomysial / anti-gliadin antibodies

after that do Endoscopy + biopsy (diagnostic, gold standard)
- crypt hyperplasia / villous atrophy / increased intraepithelial lymphocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

treatment for coeliac disease

A

avoid gluten - eat alternatives
vitamin and mineral supplements (as coeliac disease causes malabsorption)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

which vaccination is give to those with coeliac disease and why

A

pneumococcal vaccination
they get functional hyposplenism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

FBC finding for coeliac disease

A

iron deficiency anaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

Blood smear finding for coeliac disease and what does this indicate

A

target cells
Howell-jolly bodies
indicates functional hyposplenism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

what effect does coeliac disease have on the spleen

A

causes functional hyposplenism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
167
Q

most important sign suggestive of IBS

A

pain relieved by defecation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
168
Q

which extra intestinal manifestation runs its course independent of IBD activity (active luminal disease)

A

primary sclerosing cholangitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
169
Q

what medication is used to maintain remission in UC in those who’s remission is not maintained by 5 ASA

A

mercatopurine or azothioprine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
170
Q

what investigation is done to monitor for complications of coeliac disease

A

DEXA scan –> monitors for osteoporosis / osteopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
171
Q

which area is always affected in UC but often spared in crohns

A

rectum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
172
Q

what type of laxative is macrogol

A

osmotic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
173
Q

what is the first line investigation for coeliac disease in a pt who his IgA deficient

A

blood test for anti tTG IgG antibodies
(normally its for anti tTG IgA antibodies)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
174
Q

first lien med for crohns flare up

A

IV hydrocortisone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
175
Q

pt with crohns presents with pain and fresh red bleeding on defecation. what is the most likely diagnosis

A

anal fissure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
176
Q

which part of the intestine is affected by crohns disease and contributes to the formation of gallstones

A

terminal ileum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
177
Q

what is imatinib used to treat and what is its mechanism of action

A

chronic myeloid leukaemia
GI stromal tumours

inhibition of tyrosine kinase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
178
Q

which investigation differentiates IBS from IBD

A

faecal calprotein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
179
Q

what does positive faecal elastase indicate

A

chronic pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
180
Q

what do cysts on stool microscopy indicate

A

parasitic infection eg giardiasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
181
Q

what type of condition does high ALP compared to ALT/AST indicate

A

obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
182
Q

what does jaundice, pruritis and an obstructive LFT pattern in a pt with UC indicate

A

primary sclerosis cholangitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
183
Q

LFT results in PSC

A

obstructive pattern
- v high ALP compared to AST/ALT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
184
Q

MRCP results in PSC

A

multiple beaded biliary structures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
185
Q

what do you need to rule out if someone with coeliac disease presents with weight loss / recurrent diarrhoea / recurrent abdominal pain

A

enteropathy associated T cell lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
186
Q

treatment for PSC

A
  • supportive
  • liver transplant, is potentially curative but PSC can recur
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
187
Q

which condition does pain relieve by defecation indicate

A

IBS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
188
Q

pt with opiate - induced constipation has been taking movicol (osmotic laxative) to no effect. what is next step in management

A

ADD Senna

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
189
Q

best treatment for opiate-induced constipation

A

a combination of an osmotic and a stimulant laxative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
190
Q

in which pts should stimulant laxatives be avoided

A

pts with
- small bowel obstruction
- IBD
- pregnant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
191
Q

initial management in a euvolemic pt with toxic megacolon

A

urgent decompression with an NG tube

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
192
Q

which conditions is hcg raised in

A

hydatidiform moles
choriocarcinoma
gestational trophoblastic tumours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
193
Q

what is VMA (vanillylmandelic acid) raised in

A

phaechromocytoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
194
Q

which condition is CA19-9 raised in

A

cholangiocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
195
Q

which condition is CA125 raised in

A

ovarian cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
196
Q

what do raised faecal leukocytes indicate

A

bacterial infective colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
197
Q

what is a common defecation problem in enterally fed pts

A

diarrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
198
Q

what is the likely diagnosis if a pt with long-standing UC develops abnormal liver enzymes and weight loss

A

cholangiocarcinoma / biliary tract carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
199
Q

crohns pt is on steroid therapy, which med should she be put on to prevent crohns flare

A

azothioprine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
200
Q

pt underwent a bowel resection for their crohns and is now suffering with pale coloured and difficult to flush diarrhoea. what is most likely diagnosis

A

short bowel syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
201
Q

what is blepharitis and what is it most commonly caused by

A

inflammation of eyelid - red, crusty
caused by staph aureus infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
202
Q

when is tacrolimus used to treat UC

A

when pt is resistant to aminosalicylates and steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
203
Q

what is used to maintain remission in UC pts

A

azathioprine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
204
Q

if pt has an acute uC flare up and topical +oral mesalazine is not improving symptoms what do you add

A

add prednisolone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
205
Q

what medication is used to maintain remission in both uc and crohns

A

azathioprine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
206
Q

if colonscopy is normal in a pt with crohns, whats the next step in investigation

A

investigate the small bowel:
- small bowel MRI or small bowel capsule endoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
207
Q

what is loperamide used for

A

to treat diarrrhoea
so don’t give in constipation !!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
208
Q

give some iatrogenic causes of diarrhoea

A

oral magnesium replacement, penicillin, omeprazole, metformin, chemotherapy, NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
209
Q

most likely cause of hairy-looking white lesion on side of tongue

A

epstein barr virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
210
Q

likely diagnosis if a pt presents with weight loss, bloody diarrhoea, high ALP and positive p-ANCA and ANA

A

primary sclerosing cholangitis (secondary to UC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
211
Q

what are sore swollen tongue (glossitis), bleeding gums and peripheral neuropathy a sign of

A

B12 deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
212
Q

order of treatments for UC flare up

A
  1. IV hydrocortisone
  2. cyclosporin
  3. infliximab
  4. colectomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
213
Q

first line test for coeliac disease suspicion

A

total IgA + IgA tTG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
214
Q

if crohns pt presents with sepsis secondary to a perineal abscess, what is first line of investigation

A

urgent MRI pelvis
(if delay - urgent CT, if not possible - examination under anaesthetic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
215
Q

what kind of laxative is ispaghula husk

A

bulk forming

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
216
Q

what kind of laxative is macrogol

A

osmotic laxative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
217
Q

what kind of laxative is bisacodyl

A

stimulant laxative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
218
Q

what is a likely diagnosis for abdominal pain, explosive diarrhoea, bloating and flatulence after tropical travel

A

giardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
219
Q

what do pale stools (steatorrhea) indicate

A

malabsorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
220
Q

if a pt meets IBS criteria, what is the most appropriate next investigation

A

tTG antibodies, to rue out coeliac disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
221
Q

what indicates surgery with toxic megacolon

A

not responds to steroids within 48-72 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
222
Q

toxic megacolon treatment

A

NBM
IV fluids
IV hydrocortisone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
223
Q

which cause if diarrhoea shows ancathocytes, target cells and Howell jolly bodies on a a blood film

A

coeliac disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
224
Q

in which conditions should pts also be tested for coeliac disease

A

graves disease
T1DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
225
Q

first line treatment for flare up in crohns

A

prednisolone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
226
Q

what is shilling test used for

A

evaluates whether or not vit B12 deficiency is caused by pernicious anaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
227
Q

treatment for dermatitis herpetiformis

A

dapsone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
228
Q

what do aphthous ulcers in the context of weight loss and abdo pain indicate

A

crohns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
229
Q

if pt is in an acute condition/having a flare up and was suspected to have IBD (blood in stool is already seen), what is the best diagnostic investigation

A

flexible sigmoidoscopy
(colonoscopy can cause perforation in flare up)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
230
Q

what is chlorhexidine used to treat

A

oral ulcers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
231
Q

what is fluconazole used to treat

A

oral thrush , candidiasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
232
Q

what is the ABC of IBS

A

abdominal pain, bloating, change in bowel habit for at least 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
233
Q

rome IV criteria for IBS

A

on average at least 1 day/week, during past 3 months, 2 of the following
- pair related to defecation
- change in stool frequency
- change in stool form/appearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
234
Q

according to NICE, those who meet criteria for IBS should be tested to rule out which other condition

A

coeliac disease - test for anti tTG antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
235
Q

management for cramps/pains associated with IBS

A

antispasmodics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
236
Q

management for constipation dominant IBS

A

bulk forming laxatives (ispagula husk / Fybogel)
avoid lactulose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
237
Q

management for diarrhoea dominant IBS

A

Loperamide (antidiarrhoeals)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
238
Q

where is the pain in UC

A

left lower abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
239
Q

where is the pain in crohns

A

right lower abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
240
Q

contrast the diarrhoea in UC vs crohns

A

UC: bloody, mucus
Crohns: non bloody, watery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
241
Q

contrast the main symptoms a right vs left sided colorectal carcinoma

A

right: melena, diarrhoea
left: constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
242
Q

contrast colon layer involvement in UC vs crohns

A

crohns: transmural
UC: mucosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
243
Q

contrast the most commonly affected parts of gut in UC vs crohns

A

Crohns: terminal ileum
UC: rectum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
244
Q

contrast granuloma involvement in UC vs crohns

A

crohns: non caseating granulomas
UC: no granulomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
245
Q

contrast involvement pattern in UC vs crohns

A

crohns: skip lesions
UC: continuous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
246
Q

contrast smoking effects in UC vs crohns

A

crohns: smoking = Risk factor
UC: smoking = protection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
247
Q

contrast joint involvement in UC vs crohns

A

crohns: arthropathy (joint pain)
UC: ankylosing spondyliis, pyoderma gangernosum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
248
Q

what are the effects on the skin and eyes in UC and crohns

A

skin:
erythema nodosum (erythema on shins)
pyoderma gangrenosum (ulcers on legs)
mouth ulcers

eyes:
anterior uveitis (painful red eye with loss of vision and photophobia)
episcleritis (painless red eye)

(in UC, episcleritis>anterior uveitis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
249
Q

what shows on a barium enema in crohns

A

kantor’s string sign
rose thorn ulcers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
250
Q

what does a biopsy show in crohns

A

skip lesions
deep ulcers
cobblestone appliance
transmural inflammation
non caveating granulomas
increased goblet cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
251
Q

1st line treatment for crohns flare up

A

predinsiolone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
252
Q

treatment in crohns

A

induce remission:
prednisone / budesonide

maintain remission:
1st line: azathioprine (may cause myelosuppresion, reducing WCC)
2nd line: methotrexate

Bioogics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
253
Q

side effect of azothioprine

A

myelosuppression, may cause WCC reduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
254
Q

next steps if crohns colonsoscipy is normal

A

investigate small bowwel by either
- small bowel capsule endoscopy
- MRI small bowel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
255
Q

what is proctitis

A

UC involving only rectum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
256
Q

what is pancolitis

A

UC involving entire colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
257
Q

which parts of the gut can UC be found in

A

uptown the ileocaecal valve - never spreads proximally to this

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
258
Q

does crohns or UC have genetic element, and what is the genetic element

A

UC
genetic predisposition - HLA-B27

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
259
Q

rectal involvement in UC vs crohns

A

rectum is always involved in UC but often spared in crohns

260
Q

what shows on a biopsy in UC

A

continuous inflammation
crypt abscesses
no granulomas
depletion of goblet cells

261
Q

goblet cells in UC vs crohns

A

crohns: increase
UC: depletion

262
Q

what shows on barium enema in UC

A

lead pipe appearance

263
Q

AXR in UC

A

thumb printing
loss of haustra
pseudopolyps
toxic megacolon

264
Q

toxic megacolon treatment

A

IV fluids
NBM
NGT
IV hydrocortisone –> surgery if don’t respond in 48-72 hrs

265
Q

why do you need to monitor a pt on mesalazine with FBC

A

mesalazine causes agranulocytosis

266
Q

no. of bowel movements in mild, moderate, severe UC

A

mild <4
moderate 4-6 (4 or 5)
severe 6 or more

267
Q

treatment for UC

A

mild/moderate
- 5 -ASA (Mesalazine)
- topical for proctitis or proctosigmoiditis
- oral for more extensive disease or if topical doesn’t help

moderate flare up:
oral steroids

severe flare up
- 1st: IV hydrocortisone
- 2nd: IV cyclosporin
- 3rd: inflixamab
- 4th: colectomy

268
Q

treatment for maintaining remision UC

A

1st: mesalazine
2nd: mercatopurine / azothioprine

269
Q

what does MRCP show in primary sclerosing cholangitis

A

multiple beaded biliary structures

270
Q

Tx for primary sclerosing cholangitis

A

supportive
liver transplant, but it can recur

271
Q

antibodies shown in primary sclerosing cholangitis

A

ANA
p-ANCA
anti-SMA

272
Q

what do LFTS indicate in primary sclerosing cholangitis

A

obstruction (v high ALP compared to ALT/AST)

273
Q

what should symptoms of cholestasis (jaundice/ pruritis) in a pt with UC indicate

A

primary sclerosing cholangitis

274
Q

first line / gold standard step of management for GORD
then following that what are the next steps

A

1) 8 week PPI trial

if this doesn’t work, or pt displays any ALARM symptoms (>55yrs, weight loss, dysphagia)
Do endoscopy

if endoscopy is negative
Do oesophageal manometry with pH monitoring

275
Q

medication for GORD

A

PPI, can add H2 blocker (ranitidine) to this

276
Q

Symptom relief med for GORD

A

antacids

277
Q

PPI side effects

A

hypomagnesaemia
hyponatraemia (SIASH)
increased risk of C diff
osteoperosis + increased risk of fractures

278
Q

what is the surgery for GORD

A

nissens fundoplication

279
Q

2 types of oesophageal cancer

A

upper 2/3: squamous cell carcinoma
lower 1/3: adenocarcinoma

280
Q

causes of squamous cell carcinoma of oesophagus

A

alcohol
smoking
HPV
hot beverages
diet low in fruit and veg

281
Q

causes of adenocarcinoma of oesophagus

A

GORD
male sex
obesity
barrets oesophagus
hiatus hernia

282
Q

first line gold standard investigation for oesophageal cancer

A

endoscopy and biopsy

283
Q

investigation for oesophageal cancer

A

endoscopy + biopsy
CAP CT/MRI
(CAP = chest abdo pelvis)

284
Q

treatment for oesophageal cancer

A

oesophagectomy + chemo
or
chemoradiotherapy

285
Q

what is achalasia

A

decreased relaxation of LOS

286
Q

gold standard investigation for achalasia

A

oesophageal manometry - shows increased LOS pressure

287
Q

findings of barium enema in achalasia

A

birds beak appearance

288
Q

how to stage oesphegal cancer

A

CAP CT / MRI

289
Q

findings on CXR for achalasia

A

widened mediastinum

290
Q

treatment for achalasia

A

pneumatic dilatation
hellers cardiomyotomy

291
Q

2 signs of advanced disease in oesophageal cancer

A

hoarseness: compression of recurrent laryngeal nerve
horners syndrome: miosis, ptosis, anhidrosis

292
Q

signs of upper GI bleed

A

haematemesis, meleana, raised urea

293
Q

what is appendicitis caused by

A

obstruction of lumen of appendix, by faecolith, infective agents or lymphoid hyperplasia

294
Q

what is mcburneys point of tenderness and what does it indicate

A

1/3 of distance from right ASIS to umbilicus
indicates appendicitis

295
Q

what is rosvings sign and what does it indicate

A

deep palpation in LLQ elicits pain in RLQ
appendicitis

296
Q

what is obturator sign and what does it indicate

A

pain on internal rotation of flexed hip
appendicitis

297
Q

what is psoas sign and what does it indicate

A

pain on extension of hip
appendicitis or psoas abscess –> do CT abdo to check

298
Q

what is blumberg sign and what does it indicate

A

rebound tenderness in RLQ
appendicitis

299
Q

investigation for appendicitis

A

1st: FBC
CRP
abdo US
abdo CT (if US is inconclusive)

300
Q

best imaging if appendix perforation is suspected

A

erect CXR

301
Q

main FBC result in appendicitis

A

neutrophil associated leukocytosis
raised CRP

302
Q

appendicitis treatment

A

laparoscopic appendicetocmy
give prophylactic ABx before surgery (metronidazole / cefuroxime)

303
Q

2 main complications of appendicectomy

A

perforation –> peritonitis
pelvic abscess —> pain, fever, sweats, mucus diarrhoea

304
Q

causes of acute pancreatitis

A

I GET SMASHED

Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion poison
Hypercalcaemia, Hypertriglyceridaemia
ERCP
Drugs

305
Q

most common cause of acute pancreatitis in females

A

gallstones

306
Q

most common cause of acute pancreatitis in males

A

alcohol

307
Q

2 skin signs of severe pancreatitis

A

Cullens sign (periumbilical bruising)
Grey-turner sign (flank bruising)

308
Q

describe the pain in acute pancreatitis

A

severe epigastric pain that radiates towards the back
sudden onset
worse with movement

309
Q

what is the pH of body in acute pancreatitis

A

hypokalaemia metabolic alkalosis
(nausea and vomiting causes dehydration)

310
Q

which enzyme do you test for in acute pancreatitis

A

lipase(more senssitive than lipase)

311
Q

if suspect gallstones in acute pancreatitis what is the best imaging

A

ultrasound

312
Q

leukocyte levels/results in acute pancreatitis

A

leukocytosis with left shift

313
Q

what does elevated haematocrit (>44%) indicate in acute pancreatitis

A

poor prognosis

314
Q

what does elevated ALT in acute pancreatitis indicate

A

suggests that gallstones is the cause

315
Q

treatment for acute pancreatitis

A

Fluid resus
analgesia (IV morphine)
enteral feeding

316
Q

treatment for gallstones pancreatitis

A

ERCP

317
Q

what needs to be monitored very 6 months in chronic pancreatitis pts

A

HbA1c needs to be monitored very 6 months
as DM develops in majority of pts

318
Q

faeces in chronic pancreatitis

A

steatorrhea

319
Q

most sensitive test at detecting pancreatic calcification in chronic pancreatitis

A

CT

320
Q

which enzyme is measured in chronic pancreatitis

A

faecal elastase

321
Q

treatment for chronic pancreatitis

A

pancreatic enzyme supplements

322
Q

most common form of pancreatic cancer

A

primary pancreatic ductal adenocarcinoma

323
Q

signs and symptoms of pancreatic cancer

A

painless jaundice - suggests obstruction
dark urine and pale stools
pruritus
palpable mass in RUQ
non specific upper abdominal pain
weight loss and anorexia

324
Q

which part of the pancreas is the cancer if it causes obstruction to bile flow

A

head of pancreas

325
Q

cause of pruritic in pancreatic cancer

A

bile salts in circulation

326
Q

cause of pale stool and dark urine in pancreatic cancer

A

pale stool: reduced stercobilinogen
dark urine: reduced urobilinogen, increased conjugated bilirubin

327
Q

what does persistent back pain in pancreatic cancer suggest

A

retroperitoneal metastases

328
Q

what is Courvoisier’s law

A

palpable gallbladder + obstructive jaundice –> malignancy, esp pancreatic malignancy

329
Q

1st line investigation for pancreatic cancer and what does it show
and 2nd line

A

HRCT - shows “double duct sign” = dilation pancreatic and common bile ducts
if HRCT unavailable: abdo ultrasound

330
Q

LFTs in pancreatic cancer

A

high
- bilirubin
- ALP
- GGT

normal
- ALT

331
Q

biomarker for pancreatic cancer

A

CA 19-9

332
Q

treatment for pancreatic cancer

A

whipple’s resection (pancreaticoduodenectomy)
–> for lesions at head of pancreas
+ adjuvant chemotherapy

333
Q

side effects of Whipple’s resection

A

dumping syndrome
peptic ulcer disease

334
Q

surgical treatment for pancreatic cancer that is just for palliation

A

ERCP with stunting

335
Q

what is acute cholangitis

A

bacterial infection of biliary tract

336
Q

what is the organism that most commonly causes acute cholngitis

A

E coli

337
Q

2 main causes of cholangitis

A

choledocholelithiasis (gallstones in common bile duct)
Biliary strictures

338
Q

what is Reynolds pentad

A

indicates obstrcutive ascending cholangitis:

RUQ pain
jaundice
fever
hypotension
altered mental state

339
Q

what is charcots triad

A

RUQ pain
jaundice
fever

340
Q

first line investigation for acute cholangitis

A

US scan
then first intervention is ERCP: helps to observe bile duct stone and can remove it too

341
Q

how can LFTs differentiate between cholangitis and cholecystitis

A

high ALP+ALT suggest cholangitis rather than cholecystitis

342
Q

ABG in sepsis

A

low bicarbonate
raised lactate
metabolic acidosis

343
Q

MRCP vs ERCP

A

MRCP: just imaging
ERCP: imaging and therapeutic

344
Q

possible side effect of ERCP

A

ERCP can cause pancreatitis

345
Q

cholangitis vs cholecystitis

A

cholangitis = inflammation of bile duct
cholecystitis = inflammation of gallbladder

346
Q

first line treatment for acute cholangitis

A

1st: IV antibiotics
2nd: ERCP drainage after 24-48 hrs
3rd: elective cholecystectomy (when pt is well to prevent further episodes)

347
Q

factors for poor prognosis for acute cholangitis

A

hyperbilirubinaemia
high fever
leukocytosis
older age
hypoalbuminaemia

348
Q

cause of cholecytitis

A

cystic duct obstruction caused by gallstones

349
Q

cholecystitis risk factors

A

diabetes
TPN
gall bladder

350
Q

signs and symptoms of cheolcytitis

A

RUQ pain
palpable mass
fever
positive Murphy’s sign (sudden pause on insipiration during deep palpation of RUQ due to pain)
right shoulder pain
nausea
vomiting

351
Q

what is Murphy’s sign

A

sudden pause on insipiration during deep palpation of RUQ due to pain

352
Q

first lien investigations for cholecyitis if sepsis is and is not suspected

A

sepsis not suspected: US
sepsis suspected: MRI/CT

353
Q

what does US show in cholecystitis

A

thick gallbladder wall

354
Q

treatment/management for cholecystitis and how soon after diagnosis should it be done

A

IV ABx + laparoscopic cholecystectomy (+ IV fluids + analgesia + NBM)

IV ABx is supportive
laparoscopic cholecystectomy should be done 1 week after diagnosis

355
Q

risk factors for gallstones

A

5xFs
female
fat
forty
fertile
fair

OCP
rapid weight loss
sickle cell anameia (haemolytic conditions)

356
Q

what are the 2 types of gallstones and what are they made of

A

cholesterol gallstones: cholesterol + calcium carbonate

pigment gallstones: calcium billirubinate (due to increased unconjugated bilirubin, associated with haemolytic diseases eg SCA)

357
Q

what is the most common type of gallstone

A

cholesterol stones

358
Q

signs and symptoms of biliary colic/gallstones

A

colikcy RUQ pain
can radiate to right scapula
pain after eating fatty meal
Murphy’s sign egtauve
no fever
nausea and vomiting

359
Q

what is fever and LFT’s like in gallstones/biliary colic

A

no fever
normal LFTs

360
Q

what is Murphy’s sign in biliary colic

A

negative

361
Q

investigation for biliary colic

A

US (shows thin gallbladder wall)
if US negative but bile duct dilated or abnormal LFTs: MRCP

362
Q

what does US show in biliary colic vs cholecystitis

A

biliary colic: thin gallbladder wall
cholecystitis: thick gallbladder wall

363
Q

treatment for gallstones

A

analgesia
IV fluids
NBM

ERCP / electie laparoscopic cholecystectomy

if asymptomatic don’t need any treatment

364
Q

what is the site of damage in primary biliary cholangitis

A

intrahepatic bile ducts

365
Q

what do raised anti-michondrial antibodies indicate

A

primary biliary cholangitis

366
Q

which cancer does primary biliary cholangitis significantly increase the risk of developing

A

hepatocellular carcinoma

367
Q

which antibodies are see in sjogrens syndrome

A

anti Ro (SS-A)
ani La (SS-B)
rheumatoid factor
antinuclear

368
Q

which cancer does primary sclerosing cholangitis significantly increase the risk of developing

A

cholangiocarcinoma

369
Q

which antibodies are lily to be raised in primary scleroing cholangitis

A

anti-nuclear antibodies

370
Q

what is sjogrens syndrome

A

autoimmune condition affecting parts of the body that produce fluids
symptoms include dryness

371
Q

psc vs pbc

A

btw are autoimmune cholestatic liver diseases

psc:
- targets medium/large extra hepatic and intrahepatic bile ducts
- associated with IBD/colon cancer/bile duct cancer
- roughly equal M:F
- diagnosed by MRI of blue ducts
- usually not associated with smoking history
- itching, fatigue, abdo pain
- antibodies = ANA, ASMA

pbc:
- targets small intrahepatic bile ducts
- not associated with IBD/colon cancer/bile duct cancer
- F > M
- diagnosed by raised AMA / ALP
- associated with smoking history
- itching, fatigue abdo pain, dry eyes and mouth
- antibodies = AMA

372
Q

what is Whipple’s disease

A

chronic infectious disease - bacterial infection, affects joints and digestive system

373
Q

which pt demographic does Whipple’s disease mostly present in

A

middle aged white men

374
Q

triad of Whipple’s disease

A

dementia, ophthalmoplegia, myoclonus

375
Q

gold standard investigation for diagnosis of whipples disease

A

jejunal biopsy

376
Q

what does a jejunal biopsy for whipples disease show

A

stunted villi
deposition of macrophages in lamina proprietor
stains positive for PAS (period acid-Schiff)

377
Q

what is zollinger Ellison syndrome

A

gastric secreting tumour / hyperplasia of islet ells causes overproduction of gastric acid
–> results in recurrent peptic ulcers

378
Q

can pancreatic cancer present with abdominal pain

A

yes, if in body or tail of pancreas - head of pancreas presents as painless jaundice

379
Q

which syndrome causes a pancreatic cancer which presents with recurrent peptic ulcers and diarrhoea

A

zollinger Ellison syndrome

380
Q

presentation of cholangiocarcinoma

A

overt jaundice
no abdo pain

381
Q

how does typhoid fever present

A

abdo pain
weekness
headaches
rose spot rashes

382
Q

how is typhoid fever transmitted

A

faecal oral route

383
Q

what is the likely diagnosis of explosive non-bloody/mucus diarrhoea, ons 1 week after trying local food abroad

A

giardiasis

384
Q

what is the likely diagnosis of watery diarrhoea, abdominal cramps, dehydration after taking clindamycin

A

C diff infection

385
Q

3 risk factors for C diff infection

A

recent abx: clindamycin / penicillin
age over 65
prolonged stay in healthcare setting

386
Q

what is used to treat chemo-related nausea and vomiting

A

5HT3 antagonist

387
Q

what is functional dyspepsia

A

recurring symptoms of upset stomach with no obvious cause
- burning stomach pain
- bloating
- heartburn
- nausea
- vomiting
- burning

388
Q

which drug is sued for cytotoxic induced nausea and vomiting

A

Ondanestron ( 5HT antagonist)

389
Q

what is mirizzi’s syndrome

A

gallstone impacted at the neck/infundibulum of gallbladder

390
Q

what is a gallbladder muocoele

A

accumulate of bile in gallbladder due to blockage of cystic duct, usually by gallstone

391
Q

what is the calcium levels of pts with malignancies

A

hypercalcaemia

392
Q

what is the glucose level in pancreatic cancer

A

raised serum glucose (may present as impaired glucose tolerance or diabetes) as the endocrine function of the pancreas becomes damaged

393
Q

what causes achalasia

A

progressive degeneration of the ganglion cells in the myenteric Lexus - causes failure of relaxation of the LOS

394
Q

which 2 common meds can cause dyspepsia

A

NSAIDs and aspirin

395
Q

what is ‘multiple beaded biliary structures on MRCP’ seen in

A

primary sclerosis cholangitis

396
Q

which class of antibody is raised in serum of PBC pts

A

IgM

397
Q

what is portal hypertensive gastropathy

A

changes in the stomachs lining caused by elevated blood pressure in the portal vein

398
Q

what does biopsy show in PSC vs PBC

A

PSC: onion skin fibrosis

PBC: granulomas

399
Q

indications for TIPS

A

refractory ascites
budd-chiari syndrome
oesophageal variceal bleed

400
Q

first line treatment for giardiasis

A

metronidazole

401
Q

cholangiocarinoma vs pancreatico cancer symptoms

A

cholangiocarcinoma: biliary colic, jaundice
pancreatic cancer: painless jaundice

402
Q

what should painless jaundice raise a high suspicion of

A

pancreatic cancer

403
Q

if a pt has barrets oesophagus but no dysphasia, how often should they have endoscopic surveillance?

A

every 3-5 years

404
Q

what is it common for pts to expect for upto 6 weeks following treatment for giardiasis

A

lactose intolerance

405
Q

which condition does the triad of dysphagia, iron deficiency anaemia and glossitis indicate

A

Plummer vinson syndrome

406
Q

what is mallory Weiss syndrome

A

oesophageal tear secondary to severe vomiting which leads to haematemesis
common in alcoholics

407
Q

what type of stool does cholera vs giardiaisis cause

A

cholera: explosive ‘rice water’ stool
giardiasis: explosive fatty stool

408
Q

which condition should metoclopramide be avoided in

A

parkinsons

409
Q

which anti emetic should be avoided in bowel obstruction

A

metoclopramide

410
Q

what fluid rhesus is needed for a pt with acute pancreatitis

A

IV crystalloid given 4-6 hourly

411
Q

are colloid or crystalloid IV fluids used more

A

crystalloid
colloid fluids are generally not used bc of risk of anaphylaxis

412
Q

contrast dysphagia due to anatomical causes and oesophageal motility causes

A

anatomical causes: difficulty swallowing solids first and then liquids
oesophageal motility causes: difficulty swallowing liquids first and then solids

413
Q

what is a likely diagnosis of. apt with dysphagia first to solids and then to liquids, painful hands, telengiechtasia and positive anti-centromere antibodies

A

limited cutaneous systemic sclerosis (CREST syndrome)

414
Q

what is the cause of dysphagia with eosinophil infiltration of mucosa on oesophageal biopsy

A

eosinophilic oesophagitis

415
Q

what is the cause of dysphagia with upper oesophageal web on endoscopy, iron deficiency anaemia, glossitis, angular stomatitis

A

Plummer vinson syndrome

416
Q

what is a common side effect of canaglifozin

A

balanoposthitis

417
Q

what re-testing method is recommended for Hpylori after completing eradication therapy

A

urea breath test

418
Q

most likely diagnosis of pt with diarrhoea, weight loss hyperpigmentation of skin, polyarthralgia

A

whipple’s disease

419
Q

gold standard diagnosis of whipples disease

A

jejunal biopsy - stunted villi, deposition of macropjages in lamina propria which stain positive for PAS (period acid-schiff)

420
Q

Tx for Whipple’s disease

A

ABx - cotrimoxazole

421
Q

what is the criteria for urgent endoscopy

A

over 55 with weight loss
plus
reflux, dyspepsia or abdo pain

422
Q

what is a likely cause of dysphagia, regurgitation and halitosis

A

pharyngeal pouch (zenker’s diverticulum)

423
Q

which cancer is trousseau syndrome associated with

A

pancreatic cancer

424
Q

which cancer is Lambert eaton myasthenic syndrome (LAMS) associated with

A

small cell lung cancer

425
Q

what are acetylcholine receptor antibodies specific for

A

myasthenia gravis

426
Q

what antibodies are found in PBC

A

antimitochondrial antibodies (AMA)

427
Q

what antibodies are found in PSC

A

antineutrophil cytoplasmic antibodies (ANCA) (esp p-ANCA)
anti smooth muscle antibodies (SMA)

428
Q

what is the likely diagnosis if a sjogrens syndrome pt presents with fatigue and skin itchiness with raised ALP

A

primary biliary cholangitis

429
Q

drugs which induce pancreatitis

A

FAT SHEEP

F-Furosemide (lasix)
A-Asa, AZT, Asaparaginase
T-Tetracyclines
S-Statins, (sulfonamides), Steroids
H-HCTZ
E-Estrogens (OCP)
E-EtOH
P-Pentamidine

430
Q

what do you first need to rule out if a 15 year old girl comes in with abdominal pain

A

ectopic pregnancy

431
Q

what is Trousseau’s sign

A

migratory thrombophlebitis - associated with pancreatic cancer

432
Q

what 2 signs are associated with pancreatic cancer

A

Courvoisier’s sign: painless palatable gallbladder + jaundice
Trousseau’s sign: migratory thrombophlebitis

433
Q

which pt group does PBC most present in

A

women

434
Q

what is the first line treatment fro cholestatitic pruritus

A

cholestyramine

435
Q

most common type of oesophageal cancer in GORD pts

A

adenocarcinoma

436
Q

TIPSS procedure diverts some blood flow way from the liver parenchyma, what is a complication of this procedure?

A

hepatic encephalopathy

437
Q

what is a perineal abscess

A

a pus collection in the perineal region

438
Q

what is a perineal fistula

A

a chronically infected tract between the rectum and perineum

439
Q

at which stages do abscess and fistulas form in purulent perineal infections

A

abscess: acute manifestation
fistula: chronic manifestation

440
Q

main cause of perineal asbcesses and fistulas

A

flow obstruction and bacterial infection of the anal crypt glands

441
Q

contrast symptoms of perineal abscess and fistula

A

abscess: dull pain, pruritis
fistula: constant, throbbing pain

442
Q

best ix to visualise a perineal fistula’s course

A

MRI pelvis

443
Q

confirmatory tests for deeper perineal abscesses

A

MRI/CT
anal ultrasonography

444
Q

treatment and post operative care for perineal abscess

A

Tx:
surgical incision and drainage

post operative care:
sitz bath
analgesics
stool softeners
abx for immunocompromised

445
Q

treatment for normal perineal fistula

A

surgical fistulotomy (cut along the whole fistula to open and drain it)

446
Q

treatment for complex perineal fistula

A

seton placement (surgical thread placed through fistula to keep it open and allow it to be drained - stops pus forming and it healing around the pus, as that will cause other abscesses to form)

447
Q

which 2 classes of medications are risk factors for C diff

A

abx
PPIs

448
Q

which 4 antibiotics are risk factors for c diff

A

4 x C
clarithromycin
clindamycin
ciprofloxacin
cephalosporin

449
Q

what shows on a sigmoidoscopy for infectious colitis

A

yellow plaques

450
Q

if infectious colitis causes perforation what can this lead to

A

toxic megacolon

451
Q

symptoms for infectious colitis

A

possible mucus and blood in diarrhoea
fever
lower abdo pain
malaise

452
Q

what does a positive antigen stool sample for C diff indicate

A

indicates bacterial exposure but not necessarily current infection

453
Q

Tx for infectious colitis

A

hydration
loperamide (antidiarrhoeals)
Abx

454
Q

Tx for C diff

A

10 days course of oral vancomycin

455
Q

what are colonic diverticula

A

outpouchings of the colonic mucosa

456
Q

which meds can be risk factors for diverticulitis

A

NSAIDs and opioid

457
Q

Risk factors for diverticulitis

A

age > 50
low dietary fibre
constipation
diet rich in salt, meat, sugar
obesity
NSAID and opioid used
smoking

458
Q

symptoms for diverticulitis

A

LLQ pain
constipation / change in bowel habits
rectal bleeding
N & V
fever

459
Q

what does leukocytosis in someone with diverticula suggest

A

acute diverticulitis, if have symptoms too

460
Q

which scan is used for someone with suspected acute diverticulitis and raised inflammatory markers

A

contrast CT of abdo

461
Q

how does diverticulitis look on barium enema

A

saw tooth pattern

462
Q

what does riglers sign indicate on X-ray

A

(double walled gut is visible) - indicates air in the abdo (pneumoperitoneum) which could be due to gut perforation

463
Q

treatment for asymptomatic diverticulosis

A

dietary and lifestyle modifications

464
Q

treatment for acute and uncomplicated diverticulitis, and then what do u do if complications arise

A

oral abx and analgesia
if not responding after 72 hrs give IV abx (ceftriaxone + metranidazole)
if complications do Hartmanns procedure (resection of rectosigmoid colon and end colostomy is formed)

465
Q

what does pneumaturia and faecaluria indicate

A

colovesical fistula

466
Q

what does vaginal passage of faeces or flatus indicate

A

colovaginal fistula

467
Q

what are the 2 types of bowel obstruction

A

Functional ie no peristalsis - paralytic ileus

Mechanical ie a physical obstruction - SBO or LBO

468
Q

contrast the clinical and examination features of mechanical vs functional obstruction

A

mechanical:
- colicky pain
- tinkling bowel sounds, then absent
- peristalsis
- dilated bowel proximal to obstruction
- clear obstruction on scan
- no air in rectum - collapsed bowel and rectum distal to obstruction

functional:
- diffuse continuous pain
- no bowel sounds
- no peristalsis
- whole bowel is diffusely, equally dilated
- no obstruction on scan
- air in rectum

469
Q

what causes functional bowel obstruction

A

paralytic ileus, which can happen after bowel surgery

470
Q

what is the max the SB, LB and caecum can dilate to

A

3 cm
6 cm
9 cm

471
Q

contrast causes of SBO and LBO

A

SBO
hernias
adhesions
gallstones

LBO
tumour
volvulus
diverticulitis

472
Q

contrast the clinical signs of SBO vs LBO

A

SBO
early bilious vomiting
late constipation, esp if proximal obstruction
less severe abdo distention

LBO
late vomiting
faecal vomiting
early constipation
early and significant abdo distention

473
Q

what obstruction does faecal vomiting indicate

A

LBO

474
Q

contrast SBO and LBO on imaging

A

SBO
max 3cm dilated
valvular conniventes (lines go all way across)
central dilated loops

LBO
max 6cm dilated
haustra (lines don’t go all way across)
peripherally dilated loops

475
Q

1st line Ix for bowel obstruction

A

abdo xray

476
Q

gold standard diagnostic Ix for bowel obstruction

A

CTAP with IV contrast

477
Q

treatment for bowel obstruction

A

IV fluid resus
NBM
NGT decompression
analgesia
anti emetics
electrolyte replacement
surgery

478
Q

what should you monitor during post operative paralytic ileus

A

U&Es
(as electrolyte imbalance can contribute to ileus)

479
Q

acid base level in vomiting

A

hypokalaemia metabolic alkalosis

480
Q

acid base level in bowel ischameia

A

metabolic acidosis

481
Q

what 2 things in bloods indicate bowel ischameia

A

raised lactate
leukocytosis

482
Q

what are the most common sites of volvulus in adults

A

sigmoid colon
caecum

483
Q

contrast RFs for sigmoid volvulus and caecum volvulus

A

sigmoid:
older pts
chronic constipation
chagas disease
neurological conditions
psychiatric conditions

caceal:
all ages
adhesions
pregnancy

484
Q

which volvulus happen more in older pts

A

sigmoid

485
Q

where does volvulus happen in infants

A

midgut

486
Q

symptoms of volvulus

A

similar to bowel obstruction symptoms
abdo pain which decreases after explosive passage of stool or gas
distension
bililous vomiting

487
Q

what does failure to pass NG tube, epigastric pain and vomiting indicate

A

gastric volvulus

488
Q

what does bilious vomiting, haematochezia. haematomesis, hypotension and tachycardia in an infant indicate

A

midget volvulus

489
Q

how does sigmoid volvulus present on X-ray

A

coffee bean sign
2 dilated loops
LBO

490
Q

how does cecal volvulus present on X-ray

A

kidney bean/embryo sign
1 dilated loop
SBO

491
Q

how does volvulus present on CT

A

whirl sign

492
Q

how does volvulus present on barium enema

A

birds beak sign

493
Q

Surgery for sigmoid volvulus

A

rigid sigmoidoscopy with rectal tube insertion (detorsion)

494
Q

Surgery for sigmoid volvulus if peritonitis or decompression doesn’t work

A

sigmoid colectomy (take out sigmoid colon and anastamose with rectum
–> haemodynamically stable pt with viable bowel

Hartmanns procedure (signed is removed, end colectomy is formed)
–> haemodynamically unstable pt with ischaemic bowel

495
Q

surgery for cecal volvulus

A

right hemicolectomy

496
Q

Surgery for intestinal malrotation (midgut volvulus in infants)

A

Ladd procedure

497
Q

what type of cancer are the majority of colorectal tumours

A

adenocarcinomas

498
Q

contrast features/symptoms of right, left and rectal colorectal tumours

A

right sided
- melaena / occult
- iron deficiency anaemia
- diarrhoea

left sided
- changes in bowel habits
- streaks of blood
- colicky pain

rectal
- tenesumus
- flatulence
- faceal incontimnece
- haematochezia
- rectal pain

499
Q

what medication should pts take before colonoscopy

A

laxatives

500
Q

diagnostic Ix for colorectal tumours

A

colonoscopy and biopsy

501
Q

Ix to stage colorectal cancer via dukes staging

A

CT CAP

502
Q

what are Duke’s A-D of colorectal cancer

A

Dukes A - tumour confined to the mucosa
Dukes B - tumour invaded past the mucosa and thriough the bowel wall
Dukes C - lymph node metastases
Dukes D - distant metastases

503
Q

how does colorectal tumour look on barium enema

A

apple core lesion (due to stricturing)

504
Q

how to monitor disease progression for colorectal tumours

A

measure CEA - tumour marker

505
Q

screening for colorectal tumours

A

FIT test every 2 years for men and women aged 60-74

506
Q

criteria for 2 WW referral for colorectal tumour suspicion

A

60 years or older with
iron deficiency anaemia
or
change in bowel habit

507
Q

resection and anatomises for cecal, ascending or proximal transverse colon

A

right hemicolectomy
ileo-colic

508
Q

resection and anatomises for distal, transverse, descending colon

A

left hemicolectomy
colo-colon

509
Q

resection and anatomises for sigmoid colon

A

higher anterior resection
colo-rectal

510
Q

resection and anatomises for upper rectum

A

anterior resection (TME)
colo rectal

511
Q

resection and anatomises for low rectum

A

anterior resection (low TME)
colo rectal

512
Q

resection and anatomises for anal verge

A

abdomino perineal excision of rectum
none

513
Q

signs/symptoms of anastomotic leak?

A

diffuse abdo tenderness
tachycardia
rigidity
tachycardia
hypotensive

514
Q

contrast direct and indirect inguinal hernia

A

direct
- medial to inferior epigastric vessels
- through posterior wall of inguinal canal
- due to straining / weakness in abdo wall muscles
- older men

indirect
- lateral to inferior epigastric vessels
- through deep inguinal ring into inguinal canal
- due to abdo wall defects present from birth
- infants

515
Q

contrast inguinal and femoral Hernia

A

inguinal
- supermedial to pubic tubercle
- reducible
- cough impulse present

femoral
- inferolateral to pubic tubercle
- non reducible
- cough impulse absent

516
Q

what is hasselbachs triad and which hernia occurs here

A

between
- inferior epigastric vessels
- rectus border
- inguinal ligament

direct inguinal hernia

517
Q

investigations for hernia

A

groin ultrasound
Ct abdo - for obese pts

518
Q

what does raised lactate and leukocytosis indicate in context of hernia

A

strangulation
- ischaemia

519
Q

treatment of hernia if pt is medically fit

A

if pt is medically fit always do surgical mesh repair

520
Q

treatment for inguinal hernia if pt is not medically fit for surgery

A

Truss support belt

521
Q

what type of groin hernia should always be treated surgically due to strangulation

A

femoral hernia

522
Q

contrast an incarcerated and a strangulated hernia

A

incarcerated
- just trapped
- pain
- no systemic symptoms

strangulated
- blood supply cut off
- pain
- systemic symptoms eg absent bowel sounds, tender and distended abdo

523
Q

contrast a rolling and sliding hiatus hernia

A

sliding
- GOJ moves above diaphragm

rolling
- GOJ stays below diaphragm but another part of stomach eg fungus moves above diaphragm

524
Q

which hiatus hernia requires more urgent surgical intervention due to volvulus risk

A

rolling hiatus hernia

525
Q

symptoms for hiatus hernia

A

hiccups
GORD symptoms
heartburn
regurgitation
dysphagia
odnophagia
cough
chest pain
SOB

526
Q

medical and surgical treatment for hiatus hernia

A

weight loss and 4-8 weeks PPI
surgery (mainly for rolling hiatus hernia) : Nissens fundoplication and hiatoplasty

527
Q

most sensitive investigation for hiatus hernia

A

barium swallow

528
Q

first line investigation for hiatus hernia

A

upper GI endoscopy
- due to symptoms most pt have this endoscopy and the hernia is found incidentally

529
Q

what is seen on a CXR with hiatus hernia

A

retrocardiac bubble

530
Q

what are peptic ulcers caused by

A

gastric acid
pepsin

531
Q

which layer of the GI wall do peptic ulcers reach to

A

submucosa

532
Q

what is the most common peptic ulcer, gastric or duodenal

A

duodenal

533
Q

what are the most common causes of peptic ulcers

A

NSAIDs
H pylori

534
Q

which type of peptic ulcer is more common in older people (50+)

A

gastric

535
Q

which type of peptic ulcer is more common in young people (30)

A

duodenal

536
Q

contrast pain and weight changes in gastric and duodenal ulcers

A

gastric
- pain immediately after eating
- weight loss

duodenal
- pain a couple hours after eating
- eating may a make pain better
- weight gain

537
Q

what kind of pain is seen in peptic ulcers

A

epigastric “gnawing” pain

538
Q

what is gastritis

A

mucosal inflammation of GI tract

539
Q

symptoms of gastritis

A

nausea
vomiting
loss of appetite
weight losss

540
Q

gold standard diagnostic test for peptic ulcer disease

A

upper Gi endoscopy

541
Q

2 tests for H pylori

A

carbon 13 urea breath test
stool antigen tests

542
Q

which tests for H pylori can be used post eradication therapy

A

carbon 13 urea breath test

543
Q

what does CXR show in perforated gastric vs perforated duodenal ulcer

A

perforated gastric ulcer
- dome sign

perforated duodenal ucler
- pneumoperitoneum

544
Q

what does raised urea indicate

A

UPPER GI bleed as opposed to lower GI

545
Q

management plan for peptic ulcer disease in a H pylori positive vs negative pt

A

universal
- reduce smoking and alcohol

positive H pylori
- triple eradication therapy for 1 week, twice daily (omeprazole, clarithromycin, amoxicillin - or metranidazole if penicillin allergy)

negative H pylori
- stop drug causing ulcer eg NSAIDS
- omeprazole 20mg for 4-8 weeks
- gastric ulcer - repeat endoscopy 6-8 weeks later
- duodenal ulcer - repeat carbon 13 urea breath test for H pylori 6-8 weeks later

546
Q

what is the next step if a patient with peptic ulcer disease is H pylori positive and their symptoms don’t improve after triple eradication therapy

A

endoscopy

547
Q

contrast boerrhaves tear and mallory-weise tear

A

Boerrhaves tear - TEARS ALL THE WAY THROUGH
- transmural
- distal 1/3 of oesophagus
- severe sudden onset chest pain following repeated episodes of vomiting (and prolonged alcohol use)
- subcutaneous emphysema
- progresses to chest and neck pain and dysphagia

mallory weiss tear - VOMIT BLOOD, DOESNT TEAR ALL THE WAY THROUGH
- confined to mucosal membrane (mucosa and submucosa)
- haematemssis

548
Q

contrast the pain in gastroduodenal vs large bowel perforation

A

gastroduodenal
- epigatrsic pain
large bowel
- peritonitic abdo pain

549
Q

first line investigation for GI perforation

A

erect CXR
will see pneumoperitoenum

550
Q

gold standard investigation for bowel perforation

A

CT with Iv contrast

551
Q

what does riggler’s sign indicate on AXR

A

GI perforation
- double walled sign due to gas outlining both sides of the bowel

552
Q

what investigation is used specifically for oesophageal perforations

A

gastrograffin swallow

553
Q

surgical repair of large bowel perforation

A

hartmanns procedure - resection of the perforated section
peritoneal lavage

554
Q

surgical repair of gastroduodenal perforation

A

perforation is closed with omental patch

555
Q

do gastric or duodenal ulcers have higher morbidity / mortality

A

gastric

556
Q

most common pathogen cause of peritonitis

A

e coli

557
Q

most likely diagnosis if a pt with ascites secondary to liver failure presents with fever and abdo pain

A

SBP

558
Q

diagnostic test for SBP

A

paracentesis / ascitic tap
SBP if neutrophils > 250 / mm3

559
Q

2 investigations for peritonitis

A

paracentesis / ascitic tap - check neutrophil count for SBP

ascitic fluid culture - determine causative organism

560
Q

management for peritonitis

A

empirical IV antibiotics (cefotaxime)
IV albumin

561
Q

management for peritonitis if protein conc < 15 g/L or previous episode of SBP

A

continuous abx prophylaxis ( oral ciprofloxacin / norfloxacin)

562
Q

what is mesenteric adenitis

A

inflammation of lymph nodes in abdominal mesentery

563
Q

most common cause of mesenteric adenines

A

recent viral intestinal infection

564
Q

which condition can mesenteric adenitis mimic

A

appendicitis - usually has RLQ pain

565
Q

which pts does mesenteric adenines commonly affect

A

children and teenagers

566
Q

Ix for mesenteric adenitis

A

abdo ultrasound
bloods

567
Q

Tx for mesenteric adenitis

A

self limiting
fluids
paracetamol / ibuprofen
abx if caused by bacterial infection

568
Q

2 example causes of malabsorption

A

coeliac disease
IBD

569
Q

2 example causes of maldigestion

A

exocrine pancreatic insufficiency
orlistat use

570
Q

an example cause of global malabsorption

A

coeliac disease

571
Q

an example cause of partial malabsorption

A

vit B12 deficiency due to problems in terminal ileum

572
Q

deficiency of what causes alopecia and wound healing problems

A

zinc

573
Q

deficiency of what causes bleeding tendency

A

vit K

574
Q

deficiency of what causes oedema

A

protein

575
Q

deficiency of what causes muscle weakness

A

potassium

576
Q

deficiency of what causes tetany

A

calcium

577
Q

deficiency of what causes goitre

A

iodine

578
Q

what is a D-Xylose absorption test

A

tests absorptive ability of upper small intestine

579
Q

treatment for malabsorption

A

oral supplementation
calorie and protein enriched diet
Iv nutrition in severe cases

580
Q

define malnutrition

A

BMI < 18.5
or
weight loss of > 10% in 3-6 months
or
BMI < 20 and weight loss of > 5% in 3-6 months

581
Q

screening test for malnutrition and what does it measure

A

MUST
uses BMI, recent weight change and acute disease to categorise pts in high medium and low risk

582
Q

treatment for malnutrition

A

1st: ‘food-first diet’ (a nutrient dense diet)

then give ONS (oral nutritional supplements) - taken between meals

if that doesn’t work - feeding tube (enteral nutrition)

for more severe cases -parenteral nutrition (IV - doesn’t go through Gi tract)

583
Q

side effect of enteral nutrition

A

diarrhoea

584
Q

what is refeeding syndrome and how can it be avoided

A

effect of nutrition following starvation - electrolyte imbalances
hypophosphataemia, hypomagnaseamia (can cause torsades des pointes) , hypokalaemia

avoided by: if pt hasn’t eaten for 5+ days, give less than 50% of what they’re meant to receive for first 2 days

585
Q

which population has high incidence of gastric cancer

A

asia

586
Q

most common form and location of gastric cancer

A

adenocarcinoma
lesser curvature of stomach

587
Q

main 4 RF for gastric cancer

A

diet high in nitrates or salts
h pylori
smoking
pernicious anaemia

588
Q

what is pernicious anaemia

A

autoantibodies attack gastric parietal cells causing deficiency in If and vit B 12

589
Q

symptoms of gastric cancer

A

epigastric pain
dyspepsia
weight loss

590
Q

skin sign related to gastric cancer

A

acanthosis nigricans - smooth brown velvety symmetrical patches on skin

591
Q

sign of lymphadenopathy or metastases in gastric cancer

A

virchows node
- left supraclavicular region

saint Mary josephs nodule
- umbilical region

krukenberg tumour
- ovarian mass

592
Q

an ovarian mass is a rare presentation of which cancer metastases

A

gastric cancer

593
Q

1st line Ix for gastric cancer

A

upper Gi endoscopy with biopsy

594
Q

what is seen in biopsy for upper GI endoscopy of gastric cancer

A

signet ring cells

595
Q

Ix for gastric cancer staging

A

Ct CAP

endoscopic ultrasound with FNA is an alternative
MRI is used to see spread to liver

596
Q

what should you monitor after someone has gastrectomy for gastric cancer, and why

A

vit B12
can cause neurological symptoms

597
Q

2 situations which require 2 ww referral for OGD

A

dysphagia at any age

or

=> 55 yrs with weight loss + abdo pain / reflux / dyspepsia

598
Q

main 3 causes of viral gastroenteritis in order of how common

A

norovirus
sapovirus
rota virus

599
Q

main 3 causes of bacterial gastroenteritis

A

campylobacter
e coli
salmonella

600
Q

which ages does norovirus affect

A

all ages

601
Q

which viruses causing gastroenteritis affect younger children

A

rota virus
astrovirus
adenovirus

602
Q

which virus causing gastroenteritis has a longer incubation period (8-10 days) compared to others

A

adenovirus

603
Q

which virus causing gastroenteritis causes periodic diarrhoea that lasts over 10 days

A

adenovirus

604
Q

how does CMV present

A

colitis, ulceration

605
Q

which pts does CMV commonly affect

A

immunocompromised

606
Q

which virus causing gastroenteritis is spread via bodily fluids or transplanted organs/ transfused blood

A

CMV

607
Q

blood and mucus in stool
fever
malaise
dehydration
sudden onset diarrhoea
N& V
diagnosis ?

A

bacterial/viral gastroenteritis

608
Q

what can norovirus cause in frail pts (it is self limiting in healthy pts)

A

pre renal acute kidney injury

609
Q

meds for C diff

A

oral vancomycin
add metronidazole if severe

610
Q

what can campylobacter cause

A

Guillain barre syndrome

611
Q

what is Guillain barre syndrome

A

autoimmune demyelinating polyneuropathy affecting pns

612
Q

1st sign of Guillain barre syndrome

A

leg pain / weakness

613
Q

signs and symptoms of Guillain barre syndrome

A

leg pain / weakness
ascending weakness
AREFLEXIA
resp muscle weakness –> resp failure

614
Q

2 Ix for Guillain barre syndrome

A

lumbar puncture: CSF = high protein (autoantibodies), normal WCC
nerve conduction study: decreased motor nerve conduction

615
Q

Tx for Guillain barre syndrome

A

IV Ig (normal abs dilute auto abs)
plasmapheresis (filter auto abs from plasma)

616
Q

What is lynch syndrome also known as

A

Hereditary nonpolyposis colorectal cancer (HNPCC)

617
Q

Which bacteria causes gastroenteritis when food esp rice is not immediately refrigerated after cooking

A

Bacillus cereus

618
Q

Incubation. Period of campylobacter

A

2-5 days

619
Q

Most common cause of bacterial diarrhoea

A

Campylobacter

620
Q

Initial management for variceal bleeding

A

Antibiotics
Terlipressin / somatostatin (vasoconstrictors)

621
Q

Definitive management of variceal bleeding

A

Variceal band ligation

622
Q

What is given to reverse anticoagulant medication pre endoscopy

A

Prothrombin complex concentrates

623
Q

First line treatment for pt with haematemesis and melaena (ie acute non variceal upper GI bleed)

A

Endoscopic treatment

624
Q

Most definitive investigation for pharyngeal pouch

A

Barium swallow

625
Q

Likely diagnosis of a left sided mass in neck with gurgling sound on palpating, and pt experiences regurgitation

A

Pharyngeal pouch

626
Q

Which cancer is H pylori strongly associated with

A

MALT lymphoma

627
Q

Which condition causes freckles in lips, hands, soles of feet and increases risk of gastric cancer

A

Peutz Jeghers syndrome

628
Q

What is Rockall score used to measure

A

Severity of GI bleeding

629
Q

What is child Pugh score used to measure

A

Cirrhosis

630
Q

What is Glasgow score used to measure

A

Acute pancreatitis

631
Q

What is HAS-BLED score used to measure

A

risk of bleeding in pts taking anticoagulants for atrial fibrillation - score of 3+ suggests high risk of bleeding

632
Q

What should pts at high risk of refereeing syndrome be started on

A

Thiamine of pabrinex

633
Q

What are the 4 Ds of pellagra (vit B3 deficiency)

A

Dementia
Diarrhoea
Dermatitis
Death (if not treated promptly)

634
Q

What nutritional deficiency causes pellagra

A

Vit B3

635
Q

What nutritional deficiency causes beriberi

A

Thiamine

636
Q

What nutritional deficiency causes xerophthalmia

A

Vit A

637
Q

Contrast wet and dry Beriberi

A

Wet beriberi - Herat failure and peripheral oedema
Dry Berberi - peripheral neuropathy

638
Q

Tx from beri beri

A

IV pabrinex then oral thiamine

639
Q

Tx for scurvy

A

Absorbic acid

640
Q

Features of scurvy

A

Cachexia
Gingivitis
Halitosis
Gut / bladder / gum bleeding
Oedema

641
Q

Effect of grapefruit juice on cytochrome p450 enzymes

A

Inhibitor

642
Q

Effect of rifampicin on cytochrome p450 enzymes

A

Inducer

643
Q

Effect of clarithromycin on cytochrome p450 enzymes

A

Inhibitor

644
Q

Which condition requires regulate venesection / phlebotomy

A

Hereditary haemachromatosis

645
Q

Likely Diagnosis: fever, abdo pain, rash in trunk

A

Typhoid fever

646
Q

What is zollinger Ellison syndrome

A

Neuro endocrine tumour which secrets gastrin

647
Q

if a pt is having UC flare up and isn’t improving on topical and oral ASA what do you do

A

ADD oral prednisolone to the ASA